District-Level Inequalities in Hypertension among Adults in Indonesia: A Cross-Sectional Analysis by Sex and Age Group

Abstract

Background: An estimated 1.28 billion adults 30–79 years old had hypertension globally in 2021, of which two-thirds lived in low- and middle-income countries (LMICs). Previous studies on geographic and socioeconomic inequalities in hypertension among adults have limitations: (a) most studies used individual-level data, while evidence from locality-level data is also crucial for policymaking; (b) studies from LMICs are limited. Thus, our study examines geographic and socioeconomic inequalities in hypertension among adults across districts in Indonesia. Methods: We combined geospatial and quantitative analyses to assess the inequalities in hypertension across 514 districts in Indonesia. Hypertension data were obtained from the Indonesian Basic Health Survey (Riskesdas) 2018. Socioeconomic data were obtained from the World Bank. Six dependent variables included hypertension prevalence among all adults (18+ years), male adults, female adults, young adults (18–24 years), adults (25–59 years), and older adults (60+ years). Results: We also found significant geographic and socioeconomic inequalities in hypertension among adults across 514 districts. All hypertension indicators were higher in the most developed region than in the least developed region. Districts in the Java region had up to 50% higher prevalence of hypertension among all adults, males, females, young adults, adults, and older adults. Notably, districts in the Kalimantan region had the highest prevalence of hypertension, even compared to those in Java. Moreover, income level was positively associated with hypertension; the wealthiest districts had higher hypertension than the poorest districts by up to 30%, but only among males and older adults were statistically significant. Conclusions: There were significant inequalities in hypertension among adults across 514 districts in the country. Policies to reduce such inequalities may need to prioritize more affluent urban areas and rural areas with a higher burden.

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“…The World Health Organization (WHO) in 2021 estimates that the prevalence of hypertension will reach around 1.28 billion individuals with an age range of 30-79 years. The death rate is around 7.1 million people, which occurs mainly in poor countries with inadequate health systems (Oktamianti et al, 2022;Belay et al, 2022). Hypertension sufferers, according to The Indonesian Basic Health Research 2018 report, are estimated to increase from 25.8% in 2013 to 34.1% in 2018 of the total population (Astutik et al, 2020;Kurnianto et al, 2020;Oktamianti et al, 2022).…”

“…The death rate is around 7.1 million people, which occurs mainly in poor countries with inadequate health systems (Oktamianti et al, 2022;Belay et al, 2022). Hypertension sufferers, according to The Indonesian Basic Health Research 2018 report, are estimated to increase from 25.8% in 2013 to 34.1% in 2018 of the total population (Astutik et al, 2020;Kurnianto et al, 2020;Oktamianti et al, 2022). Preliminary studies in the Bangkalan Community Health Center Work Area, Bangkalan Regency, East Java Province -Indonesia, found a trend of increasing cases of hypertension.…”